BackgroundTo explore the upstream signal transduction mechanisms responsible for the imbalanced expression of glucocorticoid receptor (GR) isoforms in chronic rhinosinusitis (CRS) mucosa.MethodsAn in vitro model of Glucocorticoid resistance was established by inducing nasal polyp tissue with IL-1β. Changes in the protein and mRNA expression of GRα, GRβ and the key enzymes in the p38 MAPK and JNK signal pathways were measured, respectively, before and after being induced with different doses of IL-1β and specific inhibitors of p38 MAPK, JNK, ERK, PI3K and PKC. The Glucocorticoid sensitivity was measured using in vitro Glucocorticoid binding assay. Analysis of variance (ANOVA) was used to analyze the data.ResultsThe mRNA and protein expression levels of GRα, GRβ and key enzymes of the p38 MAPK and JNK pathways increased both in time- and concentration-dependent manners in IL-1β-induced nasal polyp tissue. The expression of GRβ increased more significantly than that of GRα, and the GRα/GRβ ratio decreased in time- and concentration-dependent manners. Statistically significant differences were found in the GRα/GRβ ratio and the mRNA expression of phospho-p38 MAPK and phospho-JNK between the IL-1β-induced groups and the control groups (P < 0.05). Either a specific inhibitor of the p38 MAPK pathway or a specific inhibitor of the JNK pathway increased the GRα/GRβ ratio and the Glucocorticoid affinity. None of the specific inhibitors of ERK, PI3K or PKC had any influence on the expression of GR isoforms.ConclusionOur results demonstrated that the imbalanced expression of GR isoforms in nasal polyp tissue induced by IL-1β in vitro is mediated through the p38 MAPK and JNK signal pathways.

Objective: Hypoglossal nerve schwannoma, especially when inside the extracranial region, is extremely rare. This report describes a new endoscopic transoral approach for the removal of extracranial hypoglossal schwannoma. Patients and Methods: Three patients (1 male and 2 females, aged 58–63 years) with extracranial hypoglossal schwannoma in the paroccipital condyle and the jugular foramen were treated solely by an endoscopic transoral approach. All patients presented signs of hypoglossal nerve paresis with hemiatrophy of the tongue. In addition, one of them had glossopharyngeal nerve paresis, and vagus nerve paresis was found in another patient. Results: In all patients, tumors underwent successful radical intracapsular removal by the endoscopic transoral approach, as confirmed by the postoperative examinations and MRI. No complications occurred during or after surgery, except that 1 patient had swallowing difficulties and a temporary right vagus palsy during the first day after surgery. All patients were followed up for 6 months, and the lack of any recurrence has been confirmed. Muscle bulk, motor and swallowing functions, and the vagus palsy improved in all patients. Conclusion: The endoscopic transoral approach is a safe and useful surgical technique for the removal of intracapsular tumors, including extracranial hypoglossal schwannomas, which involves minimal invasion.

PurposeThe purpose of this paper is to adopt a three-stage cloud-based management system for optimizing greenhouse gases (GHG) emission and marketing decisions with supplier selection and product family design in a multi-level supply chain with multiple suppliers, one single manufacturer and multiple retailers.Design/methodology/approachThe manufacturer purchases optional components of a certain functionality from his alternative suppliers and customizes a set of platform products for retailers in different independent market segments. To tackle the studied problem, a hierarchical analytical target cascading (ATC) model is proposed, Jaya algorithm is applied and supplier selection and product family design are implemented in its encoding procedure.FindingsA case study is used to verify the effectiveness of the ATC model in solving the optimization problem and the corresponding algorithm. It has shown that the ATC model can not only obtain close optimization results as a central optimization method but also maintain the autonomous decision rights of different supply chain members.Originality/valueThis paper first develops a three-stage cloud-based management system to optimize GHG emission, marketing decisions, supplier selection and product family design in a multi-level supply chain. Then, the ATC model is proposed to obtain the close optimization results as central optimization method and also maintain the autonomous decision rights of different supply chain members.

Objective: To retrospectively evaluate the effectiveness of the endoscopic endonasal removal of pituitary adenomas (PAs) with paraclival internal carotid artery (ICA) invasion. Methods: Between February 2002 and August 2009, 14 consecutive patients underwent ‘pure’ extended endonasal transsphenoidal endoscopic surgery for PAs with paraclival ICA invasion. The clinical outcomes of the patients were evaluated, including symptoms, the extent of the tumor, the amount of tumor removed and any complications. Results: Tumor removal, as assessed by intraoperative endoscopic inspection, postoperative magnetic resonance imaging and clinical evaluation, revealed total resection (cured) in 10 out of 14 PA patients, 1 subtotal resection (controlled), and 3 partial resections (improved). Three patients had recurrences and 2 underwent re-resection. A cerebrospinal fluid leak was seen in 1 patient. There were no cases of meningitis. All of the patients who had symptoms were discharged. Conclusion: Extended endonasal transsphenoidal endoscopic surgery for PAs with paraclival ICA invasion is a safe and effective alternative procedure after proper training. Moreover, the technique is less invasive and effective and requires less time than traditionally utilized procedures.

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